Original Article
Evaluation of antidiabetic prescriptions, cost and
adherence to treatment guidelines: A prospective,
cross-sectional study at a tertiary care teaching hospital
Abstract
Introduction: Diabetes mellitus is on alarming rise in India. Drug utilization studies help to identify the
adherence to standard treatment guidelines and to evaluate the rational drug usage.
Objective: To study prescription pattern, calculate the cost of antidiabetic drugs and to evaluate the adherence
to treatment guidelines in diabetic patients attending the medicine outpatient department in a tertiary care
teaching hospital.
Materials and Methods: A prospective observational study was carried out for a period of 5 months. The
diabetic patients who visited the medicine outdoor department were included. Demographic data and complete
prescription details were recorded in the structured case record form. Cost of the drug therapy was calculated
from the patient's bills. Indian Council for Medical research guidelines-2005 for diabetes management was used
to evaluate the adherence.
Results: A total of 250 patients were enrolled in the study with mean age 57.91 ± 9.37. Out of 250 patients
126 (50.4%) were male and rest were female. A total of 1,391 drugs were prescribed, with mean of 5.56 ± 2.52
drugs and out of which 539 drugs were antidiabetics with mean of 2.18 ± 0.96. In monotherapy, metformin
was frequently 218 (40.45%) prescribed. Glimepiride and metformin was the most frequently prescribed in
119 (76.28%) out of 156 antidiabetic drug combinations. Most commonly used drugs other than antidiabetics
were aspirin 146 (18.9%) and atorvastatin 119 (15.41%). Mean cost of therapy for a month for a diabetic patient
was 354.60 ± 305.72 INR. Majority 209 (83.6%) of prescriptions was in accordance to guidelines.
Conclusion: Metformin was the most frequently prescribed drug in the diabetes patient. Metformin and
glimeperide being the most frequent combination used. Majority of the prescriptions followed standard
guidelines.
Keywords:
Adherence, antidiabetic drugs, diabetic outpatients, drug utilization
INTRODUCTION
Six percent of the world population is affected by diabetes
mellitus (DM) which is a chronic metabolic disorder. [1] The
WHO defines diabetes mellitus as "A metabolic disorder of
multiple aetiology characterized by chronic hyperglycemia
with disturbances of carbohydrate, fat and protein metabolism
resulting from defects in the insulin secretion, insulin action,
or both". 121 A survey on Indian population shows that 4% of the
adults suffered from diabetes mellitus in the year 2000 and it
is expected to rise to 6% by the year 2025. [31 In developing
country like India, the maj ority of diabetics are in the age group
of 45-64 years in contrast to developed countries it is highly
prevalent in more than 65 years of age. [4] The management
of type 1 diabetes mellitus depends mainly on insulin,
whereas the oral antidiabetic drugs (OADs) are the first line
treatment for type 2 diabetes mellitus. [5] Complications due to
Khushali G.Acharya, Kartik N. Shah 1 ,
Nilay D. Solanki 2 , Devang A. Rana 1
M Pharm Student, Charotar University of Science and Technology,
'Departments of Pharmacology, Smt. NHL Municipal Medical College,
CHARUSTAT Campus, Changa, 2 Ramanbhai Patel College of Pharmacy,
Ahmedabad, Gujarat, India
Access this article online
Website:
www.jbclinpharai.org
DOI:
10.4103/0976-0105.121653
Quick Response Code
Address for correspondence:
Dr. Kartik N. Shah,
Department of Pharmacology, Smt. NHL Municipal Medical College,
Ellisbridge.Ahmedabad - 380 006, Gujarat, India.
E-mail: knshah 1 0@gmail.com
Journal of Basic and Clinical Pharmacy
<82>
Vol.4 I Issue 4 | September-November 2013
Acharya, et al. : Study of antidiabetic drug use and adherence
hyperglycemia in diabetes mellitus can be prevented by using
rational use of oral antidiabetic drugs (OADs) and insulin. [6]
Rational use of the drugs is a complex issue with a goal that is
difficult to achieve, defined as follows: "That patients receive
medications appropriate to their clinical needs, in doses that
meet their own individual requirements for an adequate
period of time, and at the lowest cost to them and their
community". t7]
Rational use of the drugs in populations can be effectively
studied with drug utilization reviews. The World Health
Organization (WHO) defines "drug utilization" as the
marketing, distribution, prescription and use of the drugs
in a society considering its consequences, either medical,
social, and economic. Drug utilization studies is an invaluable
investigational resource to study pharmacoepidemiology,
pharmacovigilance, pharmacoeconomics and
pharmacogenetics. 181 The World Health Organization (WHO)
has formulated a set of "core prescribing indicators" for
improvement in the rational drug use in the outpatient
practice. It includes the prescribing indicators, the patient
care indicators and the facility indicators. 191 Diabetes is a
chronic morbid condition which requires lifelong treatment.
So the cost of antidiabetic drug is the major deciding factor
for the patients' compliance. Selection of oral antidiabetic
drugs as first-line drug or combined therapy should be based
on both the pharmacological properties of the compounds like
efficacy, safety profile and also on the clinical characteristics
of the patient like stage of disease, body weight, BMI etc.,
There exists a wide range of variation in the prices of drugs
marketed in India and other countries of the world. Percentage
cost variation is an effective tool to find out the difference
between the various brands prescribed by prescriber in the
same setting. [10]
In 2005, Indian Council of Medical Research has given
guidelines for treatment of diabetes in which the selection of
drugs are mainly based on body mass index (BMI).
Judicious use of anti-diabetic drugs by adhering to these
guidelines will decrease the complications and cost of the
drug therapy. There are many studies carried out on drug
utilization in diabetic patients but a limited number of studies
had focus on analyses of cost and adherence to treatment
guidelines.
So, we planned to carry out this study drug utilization studies
in diabetic patient with focus on cost analyses and adherence
to standard treatment guideline.
Objectives
To study prescription pattern, calculate cost of antidiabetic
agents and to evaluate the adherence to treatment guidelines
in diabetic patients attending the medicine outpatient
department in a tertiary care teaching hospital.
MATERIALS AND METHODS
A prospective, cross-sectional study was carried out over the
duration of 5 months from October 2012 to February 2013.
All the demographic data and complete prescriptions were
collected on predesigned case record form. All the diabetic
patients attending the medicine outdoor department were
enrolled in the study after explaining the aim of the study.
Written informed consent was obtained from each patient.
Prior approval of Institutional ethics committee, hospital
superintendent and from the head of the medicine department
was obtained. Patients receiving any of the anti-diabetic drugs
were included in the study irrespective of their gender and those
patients who were pregnant and having insufficient data or
records were excluded from the study. Anatomical therapeutic
classification was used to designate each drug prescribed. 1111
Majority of drugs were prescribed by their brand names. For
those prescriptions whose generic name of the drugs and price
were not mentioned in the prescription, they were obtained
from CIMS (current index of medical specialty) 1121 and Indian
drug review (IDR) [2012 issues]. [13]
We calculated the percentage cost variation this is an indicator
of prescriber's behavior.
We collected the patient's pharmacy bills and analyzed
the retail cost of a particular drug being manufactured by
different companies, in the same strength, number and dosage
form was compared. The difference in the maximum and
minimum price of the same drug manufactured by different
pharmaceutical companies was calculated. The drugs being
manufactured by only one company or being manufactured
by different companies however, in different strengths were
excluded. Percentage cost variation was found out by using
the following formula.
Percentage cost variation =
Cost of highest priced brand - Cost of lowest price
xioo
Cost of lowest price brand
For calculation of adherence to standard diabetes guidelines
we used Indian Council of Medical Research Guidelines,
2005- [14]
Statistical analyses
All the data was entered in Microsoft Excel 20io®.The data
was calculated using MYSTAT Software 12.0® and Statistical
Package for Social Sciences Software 21.0 (SPSS)®. We
used unpaired t-test and Fischer's exact test to evaluate the
difference between two groups. P value less than 0.05 was
considered significant.
RESULTS
A total of 250 prescriptions were collected in the study during
the period of 5 months.
Highest numbers of the patients were found in the age group
of 51-60 (36%) years. Out of the 250 patients 126 (50.4%)
were male and 124 (49.6%) were female. The age difference
between two gender groups (P < 0.05) was statistically
significant as shown in Table 1. Most common co-morbid
condition was hypertension (100%).
Vol. 4 I Issue 4 | September-November 2013
<83>
Journal of Basic and Clinical Pharmacy
Acharya, et al. : Study of antidiabetic drug use and adherence
Number of drags prescribed was 1,391 (Range 2-11). Number
of drugs prescribed ranged from 2-14 drugs, with a mean of
5.56 ± 2.52 drugs. A total of 539 antidiabetic drugs were used
as shown in Table 2 and Figure 1 (Range 1-6). Most commonly
used drug was Metformin 218 (40.45%). Most common route
used oral in 95.62% followed by subcutaneous route (11.32%).
A total of 156 antidiabetic combinations were used. Most
commonly used drug combination was of Glimepiride and
Table 1: Demographic variables (n=250)
Variables
Gender
Mean±SD
lvalue
Age
Male
59.49±8.79
0.007*
Female
56.31 ±9.71
Body mass index
Male
27.16±2.85
0.066
Female
26.40±3.65
Fasting blood glucose
Male
1 15.85 + 31.46
0.480
Female
1 13.19=1=27.80
Postprandial blood glucose
Male
210.89 + 35.78
0.791
Female
209.5±46.92
No. of drugs prescribed
Male
5.59±2.48
0.8762
Female
5.54+2.59
No. of anti-diabetic drugs prescribed
Male
2.24±0.97
0.3684
Female
2.1 3 + 0.96
Cost of anti-diabetic drug therapy
Male
369±335.91
0.4390
Female
339±272.14
Anti-diabetic drug combination used
Male
0.648±0.52
0.3697
Female
0.59±0.50
*P<0.05 by using unpaired t-test,
females = 124
no. of males = 126 and no. of
Table 2: Drug use pattern of anti-diabetic drugs (n=250)
ATC code
Class of
Drugs
No. of
anti-diabetic
(ATC code)
patients*
agents
(%)
A10A Insulins and
A10AB Insulins
Insulin
61
analogues
and analogues for
(A10AB)
(11.32)
injection, fast-acting
A1 0B Blood
A10BA Biguanides
Metformin
218
glucose lowering
A10BA02
(40.45)
drugs, excl. insulins
A10BB
Glimepiride
153
Sulfonamides
A10BB12
(28.39)
Glibenclamide
1
A10BB01
(0.19)
A10BX Meglitinides
Repaglinide
10
A10BX02
(1.86)
AIOBF-Alpha
Voglibose
51
glucosidase
A10BF03
(9.46)
inhibitors
A10BG
Pioglitazone
29
Thiazolidinediones
A10BG03
(5.38)
AIOBH-Dipeptidyl
Sitagliptin,
9
peptidase 4 (DPP-4)
A10BH01
(1.30)
inhibitors
Vildagliptin
2
A10BH02
(0.37)
Metformin in 119 (76.28%) patients. Most commonly used
drugs other than antidiabetic were aspirin 146 (18.9%) and
atorvastatin 119 (15.41%).
In our study, therapy cost for a diabetic patient ranged from
15 to 2501 INR per month and most of the patients fall in the
cost range of 100-400 INR i.e. in 68.4% of the patients. Mean
cost of therapy for a diabetic patient was 354.60 ± 305.72 INR.
Percentage cost variation is shown in Table 3 which ranges from
1.47 to 181.81 for Glimepiride + Metformin + Pioglitazone
and glimepiride alone, respectively. WHO drug prescribing
indicators are shown in Table 4 and adherence to ICMR
guidelines on diabetes is shown in Table 5.
DISCUSSION
This study was carried out with aim to analyze the drug
utilization pattern in diabetic patients in medicine outpatient
3 4
No. of drugs
Figure 1: Number of anti-diabetic drug prescribed per patient
Table 3: Percentage cost variation of anti-diabetic
agents
Drugs
Glimepiride + Metformin + Pioglitazone
Insulin
Voglibose
Pioglitazone+ Metformin
Metformin
Glimepiride + Metformin
Glimepiride
Percentage cost variation
1.47
20.49
31.43
48.148
123.08
127.78
181.81
*Many patients received more than one drug. ATC: Anatomical
therapeutic chemical classification system
Table 4: WHO Core prescribing indicators
Core indicator Value
Average drugs prescribed 5.57
Generic name wise drug prescribed 4.38%
Antibiotics used 0.79%
Injections used 4.38%
Drugs listed in (Essential Drug List) India (201 1) 45.23%
Drug cost on injections 4.38%
Average drug cost (Rs)lprescription 866.63 ± 61 7.64 Rs.
Journal of Basic and Clinical Pharmacy
<84>
Vol.4 | Issue 4 | September-November 2013
Acharya, et al. : Study of antidiabetic drug use and adherence
Table 5: Adherence of treatment to indian council of
medical research guidelines, 2005
Body
Total
No. of
No. of
P valued
mass
(%)
prescriptions
prescriptions
index
according
not following
to ICMR
ICMR
guidelines (%)
guidelines (%)
< 18.5
1 (0.4)
1 (0.4)
0(0)
1.00
18.6-24.9
40(16)
38(15.2)
2 (0.8)
0.035
>25
209 (83.6)
170 (68)
39(15.6)
0.035
Total
250
209 (83.6)
41 (16.4)
#Based on fischers exact test between two groups. ICMR: Indian
council of medical research
department in a tertiary care teaching hospital. Drug utilization
research study will help for improvement in drug usage, more
focused generic brand prescribing pattern. Selecting proper
cost effective brand will help in quality of the drug usage, cost
reduction, proper dose selection and better health outcome.
Diabetes is a chronic disease requiring a lifelong treatment.
Although lifestyle modifications play an important role in
diabetes management, drugs become unavoidable in many
patients. This study was focusing on the prescription pattern
in diabetic patients attending the outpatient departments in
a hospital.
Two hundred and fifty patients were participated in our study.
Demography details shows male patients were 126 (50.4%)
and females patients were 124 (49.60%). In our study, male
and female patients were almost equal in number. However
in earlier study male predominance was seen in the study
population which is not in agreement with the results of
our study. 1151 This may be due to difference in geographical
location. Majority of 90 (36%) of the patients were found
in 51-60 years of age group and among 43 (17.2%) newly
diagnosed patients with Type-II DM, 30% were of the age
group of 41-50 years indicating that the risk of type-II DM
increases after the age of 40 years, this result was similar to
study of Roy V et al (1998). [l6] Middle age preponderance was
seen in our study which was similar to an earlier study of Das P
et al., (2011) were the patients ranged from 35-64 years. [17]
Average age of male was 59 years and female was 56 years. It
was reported in near to study of Wu et al. (1998). [l8]
Average BMI observed in our study was 27.16 ± 2.85 in male
patients and 26.40 ± 3.65 in female patients during course
of antidiabetic therapy, which implies that the patients were
overweight (BMI > 25 kg/m2) and were on the borderline
of becoming obese (BMI > 30 kg/m2), which in itself is a
well-recognized significant risk factor for diabetes mellitus. In
our study, average FBS and PPBS notified was 113.19 ± 27.80 and
209.5 ± 46.92 mg/dl respectively in female and 115.85 ± 31.46
and 0.89 ± 35.78 mg/dl respectively in male. It was higher than
that reported in the study done by Dave DJ et al. [lsI
Hypertension and hyperlipidemia was the most common
co-morbid condition associated with diabetes. Similar
result was obtained by the study conducted by Rataboli P
et al., (2007) stated that among all diabetic complications,
cardiovascular complications (hypertension) pose a major
threat. Hypertension accounted for 70.62% of the total
complication. t2 ° ]
In our study, we also found out that the genetic basis
i.e., majority of the patients had either of their parents
suffering from diabetes mellitus this finding was further
substantiated by study of Kannan et al., (2011) both showed
positive genetic preponderance in diabetic patients. [1] Most of
our patients had a history of diabetes around 5-15 years which
an earlier study also reported. 1211
In our study, most commonly used drug group used was
biguanides and sulfonylureas and not insulin as it was OPD
based as compared to other studies. [7 ' 22 ' 231 The most common
drug prescribed was metformin as compared to previous
studies done a decade back. This suggests the gradual takeover
of metformin as a first-line agent for type-2 DM in a decade.
Among sulfonylureas, selection of glimepiride and glipizide
has been recommended by Texas Diabetes Council because
these agents have lower incidence of hypoglycemia. [1] Insulin
was prescribed for 12% of patients with type 2 diabetes.
Johnson JA et al. (2006) stated that a study from Spain
reported that 25.3% of the patients were prescribed insulin.
This difference is due to difference in presentation in different
study populations. [24]
In this study it was found that combination therapy was
more used than monotherapy. A total of 156 antidiabetic
combinations were used. Most commonly used drug
combination was of glimepiride and metformin which was
a common finding seen with earlier study of V. Sivasankari
et al., and Das P et al., (2011) which also suggest combination
of biguanides and sulfonylureas was most frequently used
combination and most effective one. This combination is
most desirable and having a rational basis of use i.e. both
of this drugs act through different mechanism one is insulin
sensitizer and other insulin secretogogue. [7,17]
Most commonly used drug other than anti-diabetic drugs was
aspirin, atorvastatin and clopidogrel which suggest association
of cardiovascular disease especially hypertension and higher
blood cholesterol level in diabetes mellitus patients. Whereas
certain other drugs like pregabalin and mecobalamin were
prescribed for patients having signs and symptoms of diabetic
neuropathy.
Mean drugs prescribed per patient was 5.56 ± 2.52 whereas
study by Das P et al., (2011) suggests Mean drugs prescribed per
patient was 1.83J 171 Out of all drugs 619 (44.50%) antidiabetic
drugs were prescribed which was a similar finding of an
previous study conducted by Upadhyay D et al. (2007) where
anti-diabetics accounted for 314 (45.84%) of the total drugs. [23]
Average number of antidiabetic drugs per prescription was
1.45 which was similar to an early Indian studies. 11,221
Our study and another study of Upadhyay D et al., (2007)
reported that 95.62% of the drugs were prescribed in oral
dosage form and only insulin was prescribed by parenteral
Vol. 4 I Issue 4 | September-November 2013
<85>
Journal of Basic and Clinical Pharmacy
Acharya, et al. : Study of antidiabetic drug use and adherence
route. This was a good prescribing habit to improve patient
compliance. 1231
Data was analyzed for WHO drug utilization indicators, we
have seen a trend of using brand name for prescribing and a
very less amount of drugs was prescribed by generic names.
More and more amount of drugs should be prescribed by
generic names as it increases uniformity and decreases cost of
drug therapy. In earlier study essential drugs were prescribed
to a large extent but in our study nearly half numbers of drugs
were prescribed from essential drug list which suggest a trend
of using newer drugs in prescribing and also suggest the
influence of pharmaceutical companies in prescribing.
A very less amount of drugs was given in injections as
compared to earlier study. This finding can be explained as
we collected only outpatient prescriptions and insulin was the
most frequently prescribed drug by injection route which is
a cornerstone of type 1 DM and also this also suggest better
knowledge of the doctors about the risks and high cost of these
injections. Only few antibiotics (0.79%) were prescribed out
of all drugs it was an expected finding as patient in outpatient
department arrives only for refilling of prescription and
present mostly without infection. The percentage of generics
and drug use from essential drug list are higher when
compared to those from a study reported in Delhi by Kumar R
etal(20i3). [25]
Cost of therapy per month was higher as compared to study
by Kannan et al. w Cost of drug therapy was a cause for
non-adherence. In this study cost of the drugs per prescription
was found to be very high. The cost of prescription can be
reduced by choosing most economic drugs without changing
its quality. Similar result was obtained by the study conducted
by Kannan et al. w
Cost of prescription is important in chronic diseases like
diabetes. In our study therapy cost for a diabetic patient
ranged from 15 to 2501 INR and most of the patients fall
in the cost range of 100-400 INR per month. Mean cost of
therapy for a diabetic patient was 354.60 ± 305.72 INR, in our
study it was found higher as expected as no anti-diabetic drug
was given free of cost in our institute as compared to other
government hospitals. [1]
We found out the percentage cost of variation an estimation
of variability in cost for different brands prescribed to
the patients. Glimepiride, Metformin and Pioglitazone
combination had the least percentage cost variation i.e. 1.47
whereas Glimepiride had highest percentage cost variation
i.e. 181.81, this finding suggest availability of more brands
in Glimepiride as compared to other drugs and total cost of
treatment can be reduced drastically by using the cheapest
brand of Glimepiride and prescriber should avoid writing
the costliest brand of glimepiride in order to curtail the
total cost of drug therapy. Similar result was obtained by
the study conducted by Jadhav NB et al. (2013) Stated
that Glimepiride (1 mg) shows maximum price variation of
655-38%. [261
ICMR guidelines have suggestion that in patient less than 18.5
Body Mass Index metformin should not be used, in patients in
between 18.6 to 24.9 BMI guidelines suggest that metformin
should be used as second line OAD only in the resistance cases
after using other OAD and metformin should be combined
when used. Whereas in patients above 25 BMI first-line drug
used should be metformin. In our study majority (15.6%) of
the non-adherence was due to prescribing of other drugs in
place of metformin in the patients having BMI more than 25.
Prescribing drugs other than metformin in inappropriate
as literature showed that using in obese patient metformin
should be preferred.
CONCLUSION
Metformin was the most commonly prescribed drug.
Sulfonylurea and biguanide combination drugs were used.
In these glimepiride and metformin combination drugs were
prescribed and used commonly. Oral dosage form was the
most commonly used to increase the patient compliance in
type 2 DM. This is a good prescribing habit. In this study cost
of drugs per prescription was found to be very high. The cost
of prescription can be reduced by choosing the most economic
drugs (generic) without changing its quality. Prescribers
followed the ICMR guidelines to a large extent. The pattern
of prescription for diabetic patients should be more rational
as per our study and compliant with current evidence and
clinical guidelines.
ACKNOWLEDGMENT
We are very grateful to Dr. Pankaj R. Patel, Dean of Smt. N.H.L.
M.M.C who allowed us to complete this study.
REFERENCES
1. Kannan, Arshad, Senthil K. A study on drug utilization of oral
hypoglycemic agents in Type-2 diabetic patients. Asian J Pharm Clin
Res 2011;5:60-4.
2. About Diabetes. Available from: http://www.who.int/diabetes/action_
online/basics/en/index. html [Last accessed on 2013 Jul 20].
3. Day C. The rising tide of type 2 diabetes. Br J Diabetes Vase Dis
2001;1:37.
4. King H, Aubert RE, Herman WH. Global burden of diabetes,
1995-2025: Prevalence, numerical estimates, and projections. Diabetes
Care 1998;21:1414-31.
5. Chaudhari VP, Ganguly B. Changing pattern of prescribing antidiabetic
agents in patients suffering from diabetes mellitus. Int J Basic Clin
Pharmacol 2013;2:47-50.
6. Hermansen K, Mortensen LS, Hermansen ML. Combining insulins
with oral antidiabetic agents: Effect on hyperglycemic control,
markers of cardiovascular risk and disease. Vase Health Risk Manag
2008;4:561-74.
7. Sivasankari V, Manivannan E, Priyadarsini SP. Drug utilization pattern
of anti-diabetic drugs in a rural area of Tamilnadu, South India - A
prospective, observational study. Int J Pharm Biol Sci 2013;4:514-9.
8. Gama H. Drug utilization studies. Arq Med 2008;22:69-74.
9. Karande S, Sankhe P, Kulkarni M. Patterns of prescription and drug
dispensing. Indian J Pediatr 2005;72:117-21.
10. Misra B, Jain SK, Mehta Y. A study on availability and prices of
medicines in India. National Pharmaceutical Pricing Authority, 2002.
Available from: http://nppaindia.nic.in/indexl.html. [Last accessed on
2013 Jul 20].
Journal of Basic and Clinical Pharmacy
<86>
Vol.4 I Issue 4 | September-November 2013
Acharya, et al. : Study of antidiabetic drug use and adherence
11. WHOCC-ATC/DDD Index. Available from: http://www.whocc.no/
atc_dddindex/[Last accessed on 2013 Jul 20].
12. CIMS-Asia. Available from: http://www.cimsasia.com/IXast accessed
on 2013 Jul 20].
13. Malik A, Malik S. Indian Drug Review Compendium. 1 st ed. India:
Mediworld Publications; 2012.
14. Section 7. Pharmacological Treatment For Diabetes. ICMR Guidelines
for Management of Type 2 Diabetes- 2005. Available from: icmr.nic.in/
guidelines_diabetes/section7.pdfT[Last accessed on 2013 Jul 20].
15. Abdi SA, Churi S, Kumar YS. Study of drug utilization pattern of
antihyperglycemic agents in a South Indian tertiary care teaching
hospital. Indian J Pharmacol 2012;44:210-4.
16. Roy V, Rewari S. Ambiguous drug pricing: A physician's dilemma.
Indian J Pharmacol 1998;30:404-7.
17. Das P, Das BP, Rauniar GP, Roy RK, Sharma SK. Drug utilization
pattern and effectiveness analysis in diabetes mellitus at a tertiary care
centre in Eastern Nepal. Indian J Physiol Pharmacol 2011;55:272-80.
18. Wu SY, Lung BC, Chang S, Lee SC, Critchley JA, Chan JC. Evaluation
of drug usage and expenditure in a hospital diabetes clinic. J Clin Pharm
Ther 1998;23:49-56.
19. Dave DJ, Dikshit RK, Gandhi AM. Utilization of some newer oral
antidiabetic agents in a tertiary care hospital. Natl J Physiol Pharm
Pharmacol 2012;2:146-51.
20. Rataboli PV, Dang A. Antimicrobial price variation: Conundrum of
medical profession. J Postgrad Med 2007;53:72-4.
21. De Pablos-Velasco PL, Martinez-Martin FJ, Molero R,
Rodriquez-Perez F, Puente G, Caballero A. Pattern of prescription
of hypoglycemic drugs in Gran Canaria (Canary Islands, Spain) and
estimation of the prevalence of diabetes mellitus. Diabetes Metab
2005;31:457-62.
22. Sultana G, Kapur P, Aqil M, Alam MS, Pillai KK. Drug utilization of
oral hypoglycemic agents in a university teaching hospital in India. J
Clin Pharm Ther 2010;35:267-77.
23. Upadhyay DK, Palaian S, Ravi Shankar P, Mishra P, Sah AK.
Prescribing pattern in diabetic outpatients in a Tertiary Care Teaching
Hospital in Nepal. J Clin Diagn Res 2007;3:248-55.
24. Johnson JA, Pohar SL, Secnik K, Yurgin N, Hirji Z. Utilization of
diabetes medication and cost of testing supplies in Saskatchewan, 200 1 .
BMC Health Serv Res 2006;6:159.
25. Kumar R, Kohli K, Kajal HL. A study of drug prescribing pattern and
cost analysis among diabetic patients in a Care Teaching Institute in
North India. J Drug Deliv Ther 2013;3:56-61.
26. Jadhav NB, Adhav MSBCV. Cost analysis study of oral antidiabetic
drugs available in Indian market. Int J Med Res Health Sci
2013;2:63-9.
How to cite this article: Acharya KG, Shah KN, Solanki ND, Rana DA.
Evaluation of antidiabetic prescriptions, cost and adherence to treatment
guidelines: A prospective, cross-sectional study at a tertiary care teaching
hospital. J Basic Clin Pharma 2013;4:82-7.
Source of Support: Nil, Conflict of Interest: No.
Vol. 4 | Issue 4 | September-November 2013
<87>
Journal of Basic and Clinical Pharmacy